An Idaho Town’s Little Clinic That Could
May 25th, 2019 by Lori Russell

Nursing student Quincy Heithecker treats Allen Hardman’s thumb, which was injured in “a wrestling match with a pallet.”

In early 2014, when the global commodities market softened, the tiny central Idaho town of Challis braced for massive layoffs at the local mine.

As the largest employer in the area, the mine provided health insurance for about 400 of the town’s 1,000 residents.

Kate Taylor, executive director of the Challis Area Health Center—the only medical clinic within 60 miles—knew the potential loss of revenue from the layoffs could be lethal for the clinic. It had enough financial reserves to survive for about 18 months before it would have to close its doors.

“The thought of going broke brings a lot of mental clarity,” Taylor says. “We needed to come up with a new and sustainable financial way forward.”

Taylor reached out to the Idaho Primary Care Association, a state organization of Federally Qualified Health Centers, also known as community health centers. The centers combine the resources of local communities with federal funds to establish clinics in both rural and urban areas around the nation.

Approximately one in five rural residents is served by a center, according to the Health Resources and Services Administration.

Health centers provide comprehensive health services including primary care, behavioral health, chronic disease management and preventive care. These outpatient clinics qualify for grants through HRSA to serve an underserved community or service area and receive specific reimbursement under Medicare and Medicaid.

Realizing Challis met the HRSA definition of a medically underserved area, Taylor worked with the clinic’s board of directors, community members, health care providers and other stakeholders to develop a proposal for how to meet the community’s needs.

“I had all kinds of scabs on my knees from reaching out and begging for help,” she says.

One month after Taylor submitted a grant application for the clinic in October 2014, the mine laid off more than 80 percent of its workers.

While the number of clinic visits dropped, volunteer EMTs—many displaced workers from the mine—moved out of town, and the local ambulance service struggled to respond to emergency calls.

The community’s health services were on life support, and the prognosis didn’t look good.

In August 2015, 10 months after submitting its grant proposal, Challis’ clinic was awarded the funding it needed.

Today, the clinic provides comprehensive primary and preventive medical care and behavioral services for residents of Challis and North Custer County. Its integrated care model means residents can receive services in one location regardless of their ability to pay.

“We see everything,” says Steve Rembelski, who took over as the clinic’s executive director in 2016. “Primary care, seizures, heart attacks, strokes, broken legs, lacerations—I can’t think of anything we haven’t seen.”

Challis has no full-time physicians, but thanks to grant funding, the clinic added two physician assistants, bringing its total to four. The advanced-practice medical providers work under the supervision of Dr. Richard Paris, a family medicine physician who has served as the clinic’s medical director since 1999.

Paris makes the 30-minute flight from Hailey, Idaho, in his single-engine Cessna twice a month to supervise and consult with the PAs in Challis. He also follows obstetrics patients and arranges to deliver their babies at the hospital in Hailey, a 2.5-hour drive away.

Dr. Kathryn Woods, a family practice doctor and Paris’ spouse, travels with him once a month to provide women’s health services.

Paris says the community’s needs have always fluctuated.

“I’ve seen it go from two full-time doctors to barely enough work for one PA and me,” he says.

Each PA in Challis works a four-week rotation—two weeks in the clinic seeing patients, one week answering calls from the Care Line, which patients can call for health advice 24/7, and one week off. The PAs also provide backup at the clinic when things get busy. If necessary, they sometimes meet patients at the center outside of usual business hours to save them the 120-mile round trip to the closest ER.

“The whole idea of our care model is to support the community from within,” says Danny Fife, one of the PAs.

During their on-call week, providers also work as ambulance-based clinicians, riding with volunteer EMTs. Danny has flown with backcountry pilots, worked with the area search and rescue team and delivered a baby in the back of an ambulance. The PAs also arrange air transport for critically ill or severely injured patients to one of Idaho’s large hospitals.

“We are doing everything we can to care for patients,” Danny says. “It’s what I love about my job. It is what a PA is made for—extending the reach of physicians. This is how medicine should work—collaboration, not competition.”

In 2017, Challis added a full-time licensed clinical social worker who assists people with mental health and other issues, including grief, anxiety, depression and substance abuse.

A community health paramedic manages the volunteer EMS program, collaborates with the PAs and makes follow-up home visits to patients who would benefit from extra monitoring and instruction to prevent future 911 calls. The community health worker provides health education, prevention and outreach in the community.

When Challis’ only pharmacist retired, the clinic partnered with the Idaho State University School of Pharmacy to create a telepharmacy so patients could continue to get their medicine in town.

“With our new care model, there is camaraderie and teamwork,” Paris says. “There is so much power and enthusiasm.”

The once-struggling clinic has become a health care lifeline for its community, ensuring Challis residents can find the care they need when and where they need it.